| NPI | 1356894869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618002920) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00669300) |
| Enumeration Date | 2016-08-02 |
| Last Update Date | 2023-08-02 |